Vascular Access Failure

Catheter related bloodstream infections are not only responsible for prolonged hospital stays and increased hospital costs, it is also responsible for increased mortality of the hospitalized patients. According to Centers for Disease Control and Prevention (2017), an estimate of 30,100 central line-associated bloodstream infections (CLABSI) occur in intensive care units and wards of U.S. acute care facilities each year. CLABSI is a serious hospital-acquired infection that occurs when bacteria enters the bloodstream through central venous catheters. CLABSI is preventable as long as health-care personnel practice aseptic techniques when working with the catheter. A blood culture swabbed from the tip of the catheter is needed to confirm the

Getting an infection from improper care during or after insertion of a central line is the last thing you want to get while in the hospital. This paper will discuss Kaiser Permanente’s policy on central venous catheter, also known as a central line, care and dressing change, and whether it follows the current evidence-based practice on preventing bloodstream infection in patients who have them inserted. I will explain about what a central line is, why evidence-based practice is important in the clinical setting, what Kaiser Permanente’s policy about central line care and dressing change is, if Kaiser is currently following evidence-based practice based on current articles about preventing central line associated bloodstream infections (CLABSIs), and what my role in using evidence-based practice is as a future registered nurse.

Usage of indwelling urinary catheters in critically ill patients can seem to be a permanent fixture in intensive care units. Most critical care nurse expect their patients to have an indwelling urinary catheter (IUC) in place without much regard to the risk of catheter associated urinary tract infections (CAUTI) or the ability to implement IUC alternatives. Critical care patients may require IUC usage due to diagnosis, need for accurate hourly intake and output measurements, or other specified documented reasons. The risk of acquiring a catheter associated urinary tract infections is a result of IUC usage. The Centers for Disease Control and Prevention’s Guideline for Prevention of Catheter-associated

The ICUs are associated with over 15 million catheter days while there is indication that only 24.4% of CVC use occurs outside the ICUs (Chopra, Krein, Olmsted, Safdar & Saint, 2013). This implies that millions of patients in the ICUs are at a high likelihood of developing CLABSI

Signs of infection of the central venous catheter (CVC) site include redness, drainage, and the client will exhibit chills, fever, and an elevated white blood cell count (Ignatavicious & Workman, 2016). However, it is important to note that the incidence of CLABSIs in United States ICUs have decreased by 58% from 2001 to 2009, saving 3,000 to 6,000 lives as well as $414 million (Dumont & Nesselrodt, 2012). Some hospitals also report to have zero incidences of CLABSIs in their ICUs (Dumont & Nesselrodt, 2012). The pathogen that showed the greatest decrease was staphylococcus aureus (78% decrease), followed by Enterococcus (55% decrease), Candida (46% decrease) and Gram-negative bacteria (37% decrease) (CDC, n.d.).

In reviewing Heparin flushes in Central Venous Catheters (CVCs); one must first understand the importance of their placement. To properly investigate central venous catheter (CVC) care; documentation will focus on Heparin flushes as it relates to renal care. The renal dialysis patient undergoes CVC placement as a basis of receiving hemodialysis treatments. It is essentially the first access point placed in preparation of a more permanent access point. Central venous catheters, fistulas, and grafts are considered the lifeline of a dialysis patient. Their function and patency is of the utmost importance to the morbidity and mortality rate of a renal patient. “Venous catheters generally develop a fibrin sheath at the tip, which evolve into a clot due to body’s physiological response to the vein injury and the foreign catheter 1 and subsequent catheter obstruction.” (Journal of Evolution of Medical and Dental Sciences, 2014, pg. 46).

The hospital’s current practice for CAUTI prevention includes the use of the HOUDINI protocol. This protocol features the acronym for the strict indications required for the insertion and the continued use of the urinary catheter (hematuria, obstruction, urologic surgery, decubitus ulcer, intake and output, no code/comfort care, and immobilization). The physician places the original order for the catheter with HOUDINI protocol and chooses the indication that applies. The order empowers the nurse to assess the patient daily for the continued indications and to remove any urinary catheter that no longer meets the indications. Hospital wide the protocol has been successful at decreasing CAUTI rates, however the target for CAUTI rates is 0 and our current rate is 1.37 per 1000 catheter days. Intensive care units have higher urinary catheter usage than in medical surgical or telemetry units (Halm, O’Conner, 2014). In MICU the most common indication for a urinary catheter is the need for accurate intake and output on patients with hemodynamic instability. Staff nurses are required to assess the patient daily and readdress the continued indications. In the past month no urinary catheters were removed

(Gould, Umscheid, Agarwal, Kuntz, Pegues, and the Healthcare Infection Control Practices Advisory Committee, 2009) Other appropriate times would be the need to monitor intake and output or core body temperature in critically ill patients. (Parker et al., 2009) It is also recommended that catheters be removed as soon as possible and preferably within 24 hours. (Gould, Umscheid, Agarwal, Kuntz, Pegues, and the Healthcare Infection Control Practices Advisory Committee, 2009) The basis of this recommendation is that the number one risk factor for CAUTI is prolonged use of urinary catheters (United States Centers for Disease Control and Prevention, 2015). Despite this, there are times when long term use of a catheter is considered appropriate. These would include prolonged periods of total immobility due to spinal surgery or injury, in palliative care, and to assist in healing of open sacral or perineal sores exacerbated by incontinence. (Gould et al., 2009) For these times it is important to find an intervention that will prevent the development

CLABSI is the acronym for central line associated blood stream infection. CLABSI are the third leading cause of hospital acquired infection (HAI). Central line associated infections are life threatening and is a common risk factor associated with central venous catheters (CVC). Peripherally inserted central catheters are a common type of CVC used. Research is conducted to determine whether there is a benefit to reducing CLABSI with use of PICC lines that are coated with antimicrobials. This research compares the impact of chlorhexidine impregnated verses non- chlorhexidine PICC with the risk of CLABSI and VTE development in patients that are immune suppressed, critical care or trauma patients.

In my present role of in-patient transplant coordinator, I round with the transplant surgical team daily. The interdisciplinary team is aggressively looking for opportunities to minimizing opportunistic infections for example: de-escalating antibiotics, removing bladder catheters, as well as removing central lines. If the patient is a hard stick, a peripherally inserted central catheter (PICC) is placed. A study by Rutkoff, (2014) mentioned that an integration of antimicrobial PICCs into the current infection prevention practices should be practiced for reduction central line associated blood stream infections.

However, one of the most critical advances to the prevention of central line-associated bloodstream is the identification of individual risk factors that are linked to this condition. They include long hospital stays prior to venous catheterization, heavy microbial colonization within the insertion site, prolonged duration of catheterization, and femoral or internal jugular vein insertion (Goode, Fink, Krugman, Oman & Traditi, 2011). Other simple preventive measures include: performing hand hygiene, using sterile gloves,

Intravenous (IV) catheter Insertion is performed for almost all the children admitted in the hospital. It is estimated that in United States 60-90% of the children hospitalized use IV catheters (Hadaway, 2010, Helm et al., 2015)7. The most common complications of IV catheterization are infiltration

The vascular assessment of a patient is an invaluable tool in the diagnosis and management of a condition. As podiatrists, it is essential to accurately assess the blood supply of the foot as even the slightest inaccuracy has the potential to become a catastrophic repercussion. Therefore, it is crucial that the vascular system is fully understood. It is also fundamental to note that, just as patients are unique, so is their anatomy. While many anatomical reference books provide a standardized anatomical positions of the arteries of the foot, it is important to recognize that variations of anatomy are a reality and must be taken into consideration during assessment.

Recently, several studies reported that SP TFESI is a safer alternative to the conventional SA approach, because of the risk of vascular complications [20]. This study aimed to investigate the contrast spreading pattern and its correlation with efficacy for SP TFESI. Contrast was examined for the spread to both the ventral and dorsal epidural spaces, and in cephalic and caudal directions. Clinical efficacy was significantly correlated with the cephalic spreading pattern. These results indicate that the spreading of injectate could be one of the factors determining the clinical efficacy in SP TFESI.

Arterial insufficiency is a condition in which the flow of blood slows or stops through your arteries .Arteries are blood vessels that carry blood from the heart to other parts in the body .Gradually, over several years, the walls absorb increasing amounts of circulating lipids and lumen of arteries narrows (stenosis ) or may close completely . This buildup of fat and mineral deposits is called plaque .Often the terms arteriosclerosis and atherosclerosis are used interchangeably. These disease may affect the heart valves and may lead to hypertension or CAD.